RESEARCH ARTICLE
Antiretroviral Treatment Scale-Up and Tuberculosis Mortality in High TB/HIV Burden Countries: An Econometric Analysis Isabel Yan1, Eran Bendavid2,3, Eline L. Korenromp4,5*
a11111
1 Department of Economics and Finance, City University of Hong Kong, Kowloon, Hong Kong, 2 Division of General Medical Disciplines, Stanford University, Stanford, California, United States of America, 3 Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California, United States of America, 4 Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands, 5 Avenir Health, Geneva, Switzerland * [email protected]
Abstract OPEN ACCESS Citation: Yan I, Bendavid E, Korenromp EL (2016) Antiretroviral Treatment Scale-Up and Tuberculosis Mortality in High TB/HIV Burden Countries: An Econometric Analysis. PLoS ONE 11(8): e0160481. doi:10.1371/journal.pone.0160481 Editor: Antonio G. Pacheco, Fundacao Oswaldo Cruz, BRAZIL
Introduction Antiretroviral therapy (ART) reduces mortality in patients with active tuberculosis (TB), but the population-level relationship between ART coverage and TB mortality is untested. We estimated the reduction in population-level TB mortality that can be attributed to increasing ART coverage across 41 high HIV-TB burden countries.
Received: January 28, 2016
Methods
Accepted: July 20, 2016
We compiled TB mortality trends between 1996 and 2011 from two sources: (1) national program-reported TB death notifications, adjusted for annual TB case detection rates, and (2) WHO TB mortality estimates. National coverage with ART, as proportion of HIV-infected people in need, was obtained from UNAIDS. We applied panel linear regressions controlling for HIV prevalence (5-year lagged), coverage of TB interventions (estimated by WHO and UNAIDS), gross domestic product per capita, health spending from domestic sources, urbanization, and country fixed effects.
Published: August 18, 2016 Copyright: © 2016 Yan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All data are available from within the paper, S1 Table, and their quoted public sources, notably including: WHO Stop TB country databases:http://www.who.int/tb/country/data/ download/en/, AIDS Info Online, UNAIDS: http://www. aidsinfoonline.org/devinfo/libraries/aspx/Home.aspx, World Health Organization. 2011. Indicator and Measurement Registry version 1.7.0. Geneva. http:// apps.who.int/gho/indicatorregistry/App_Main/view_ indicator.aspx?iid=3430 and World Bank. World Development Indicators database. http:// siteresources.worldbank.org/DATASTATISTICS/ Resources/GNI.pdf.
Results Models suggest that that increasing ART coverage was followed by reduced TB mortality, across multiple specifications. For death notifications at 2 to 5 years following a given ART scale-up, a 1% increase in ART coverage predicted 0.95% faster mortality rate decline (p = 0.002); resulting in 27% fewer TB deaths in 2011 alone than would have occurred without ART. Based on WHO death estimates, a 1% increase in ART predicted a 1.0% reduced TB death rate (p
Antiretroviral Treatment Scale-Up and Tuberculosis Mortality in High TB/HIV Burden Countries: An Econometric Analysis Isabel Yan1, Eran Bendavid2,3, Eline L. Korenromp4,5*
a11111
1 Department of Economics and Finance, City University of Hong Kong, Kowloon, Hong Kong, 2 Division of General Medical Disciplines, Stanford University, Stanford, California, United States of America, 3 Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California, United States of America, 4 Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands, 5 Avenir Health, Geneva, Switzerland * [email protected]
Abstract OPEN ACCESS Citation: Yan I, Bendavid E, Korenromp EL (2016) Antiretroviral Treatment Scale-Up and Tuberculosis Mortality in High TB/HIV Burden Countries: An Econometric Analysis. PLoS ONE 11(8): e0160481. doi:10.1371/journal.pone.0160481 Editor: Antonio G. Pacheco, Fundacao Oswaldo Cruz, BRAZIL
Introduction Antiretroviral therapy (ART) reduces mortality in patients with active tuberculosis (TB), but the population-level relationship between ART coverage and TB mortality is untested. We estimated the reduction in population-level TB mortality that can be attributed to increasing ART coverage across 41 high HIV-TB burden countries.
Received: January 28, 2016
Methods
Accepted: July 20, 2016
We compiled TB mortality trends between 1996 and 2011 from two sources: (1) national program-reported TB death notifications, adjusted for annual TB case detection rates, and (2) WHO TB mortality estimates. National coverage with ART, as proportion of HIV-infected people in need, was obtained from UNAIDS. We applied panel linear regressions controlling for HIV prevalence (5-year lagged), coverage of TB interventions (estimated by WHO and UNAIDS), gross domestic product per capita, health spending from domestic sources, urbanization, and country fixed effects.
Published: August 18, 2016 Copyright: © 2016 Yan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All data are available from within the paper, S1 Table, and their quoted public sources, notably including: WHO Stop TB country databases:http://www.who.int/tb/country/data/ download/en/, AIDS Info Online, UNAIDS: http://www. aidsinfoonline.org/devinfo/libraries/aspx/Home.aspx, World Health Organization. 2011. Indicator and Measurement Registry version 1.7.0. Geneva. http:// apps.who.int/gho/indicatorregistry/App_Main/view_ indicator.aspx?iid=3430 and World Bank. World Development Indicators database. http:// siteresources.worldbank.org/DATASTATISTICS/ Resources/GNI.pdf.
Results Models suggest that that increasing ART coverage was followed by reduced TB mortality, across multiple specifications. For death notifications at 2 to 5 years following a given ART scale-up, a 1% increase in ART coverage predicted 0.95% faster mortality rate decline (p = 0.002); resulting in 27% fewer TB deaths in 2011 alone than would have occurred without ART. Based on WHO death estimates, a 1% increase in ART predicted a 1.0% reduced TB death rate (p
